HIV TESTING POLICY

HIV Testing as a policy issue deals with the federal and state laws affecting HIV testing, HIV testing efforts through public health entities and programs, and coverage and reimbursement of HIV testing by insurers.

For more information on the clinical aspects of HIV Testing, visit our Provider Resources Section and our Clinical Topics Library, and view the HIV Testing clinical topic page and the Routine HIV Testing pages

Background

The CDC estimates that there are 56,000 transmissions of HIV in the U.S. each year. Of this number, the CDC estimates that 18% of all HIV-infected individuals are unaware they are HIV positive. About half of new infections are caused by persons who are unaware of their status.

HIV testing has enabled individuals with HIV to become aware of their health status and to take appropriate precautions to preserve their health.

Identifying people with HIV disease earlier and connecting them with HIV care and treatment earlier results in better health outcomes and the delivery of more cost effective care.

The use of antiretroviral therapy by infected persons also drastically reduces their infectiousness. Additionally, studies have shown that people who know their HIV positive status are more likely to take precautions to reduce the spread of HIV disease. So identifying those with the disease offers a significant public health opportunity to get infected individuals into care and treatment, and also prevent others from contracting the disease.

Currently:

The National HIV/AIDS Strategy noted the role of testing in allowing individuals to be made aware of their status, to take action to preserve their health, and take precautions to reduce the likelihood of transmission.

The Strategy set a goal for expanding the number of people who know of their HIV infection from 79% to 90%. It also set goals for better coordination and promotion of HIV testing throughout various federal agencies.

HIV Testing Laws:

Some states still have laws that are not fully compatible with CDC recommendations in the
areas of counseling and consent. This may impede testing efforts.

Learn more about HIV Testing Laws and the CDC’s policy recommendations on HIV Testing

Coverage and Reimbursement of HIV Testing

HIV screening among the general population is cost effective and the cost is comparable to other screenings and medical interventions.

One barrier to promotion of HIV testing is a lack of coverage of, or inadequate reimbursement for testing procedures.

Learn more about HIV Testing Coverage and Reimbursement issues.

HIV TESTING LAWS

Many states have laws in the area of HIV testing that may impede testing efforts, encourage discrimination, or are not based on current medical science or public health models.

AAHIVM supports continued efforts to promote the policy recommendations in the area of HIV testing endorsed by the Centers for Disease Control and Prevention. We encourage working with public health officials and lawmakers in these states to further promote CDC testing efforts.

Background

In 2006, the Centers for Disease Control and Prevention (CDC) issued the Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings which endorsed making HIV testing a part of routine medical care for people ages 13 to 64 in all healthcare settings, and for all pregnant women.

The CDC recommended the following policies regarding routine HIV screening for all patients ages 13-64 in all health-care settings:

  • HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
  • Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
  • Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings.

Following the release of the 2006 Revised Recommendations, most states changed amended, or added state laws to come into alignment with the CDC’s recommendations on counseling and consent procedures for HIV testing.

Additional Information:

The National Clinicians Consulatation Center publishes a Compendium on State HIV Testing Laws that details HIV testing laws in each state.

COVERAGE AND REIMBURSEMENT FOR HIV TESTING

One barrier to promotion of widespread HIV testing is a lack of coverage of, or inadequate reimbursement for testing procedures.

HIV screening among the general population is cost effective and the cost is comparable to other screenings and medical interventions.

Identifying people with HIV disease earlier and connecting them with HIV care and treatment earlier results in better health outcomes for patients and the delivery of more cost effective care.

Background

Historically, HIV screening was not widely covered under most major insurance plans or by government payers. Private insurance is not the primary source of reimbursement for the majority of the providers who treat populations most likely to be infected. Medicaid and other government payers provide coverage for the majority of HIV patients.

In 2006, the Centers for Disease Control and Prevention (CDC) issued the Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings which endorsed making HIV testing a part of routine medical care for people ages 13 to 64 in all healthcare settings. In the recommendations, inadequate reimbursement was identified as a major barrier to implementation routine HIV screening.

Currently:

Medicaid is the primary health coverage for the majority of persons living with HIV/AIDS in the U.S. Many private insurance companies base their reimbursement schedule on CMS reimbursements.

Strides have been made in recent years to change both of these issues. AAHIVM has worked tirelessly on the issue, and helps lead an active working group of HIV organizations focused on the issue.

USPSTF:

The U.S. Preventive Services Task Force (USPSTF) is an independent body of experts tasked with providing recommendations to the Federal Government preventive health services. The USPSTF assigns grades to prevention services, and those grades inform federal coverage policies, and also serve inform services under many private insurance plans. In most cases, services graded at an “A” or “B” level are covered.

As of April 2013, the USPSTF recommends the following:

  • The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened. (Grade A)
  • The USPSTF recommends that clinicians screen all pregnant women for HIV, including those who present for labor who are untested and whose HIV status is unknown. (Grade A)

Medicaid:

State Medicaid programs have the option of covering HIV testing. However, at present, there is little data on which states offer HIV testing, or reimburse for HIV testing (either for routine testing, or risk-based) and other prevention services.

In 2010, HHS announced a decision to mandate coverage of routine testing as an essential benefit for women covered by Medicaid. Oddly, this actually created an imbalance, where men within the program are not covered for testing at the same level as women.

Medicare:

In 2011, Medicare announced that it would reimburse for HIV Testing for all beneficiaries once a year, and also for pregnant women and those at high risk. HIV testing is also covered under the initial “Welcome to Medicare” visit.

Additional Information:

OUR ADVOCACY EFFORTS

Listed below are some of AAHIVM’s advocacy efforts on the issue of HIV Testing Policy and HIV Testing Reimbursement.

Comments from AAHIVM and the HIV Health Care Access Working Group to NCD on HIV Screening 09.02.2014
Comments from AAHIVM and the HIV Health Care Access Working Group in support of NCD’s proposal on routine testing for HIV.

Comments to HHS on Proposed New HIV Objectives for Healthy People 2020 12.4.13
Comments from AAHIVM and the HIV Health Care Access Working Group to HHS on proposed new HIV objectives for Healthy People 2020.

AAHIVM Comments to USPSTF on Coverage of HIV Testing
AAHIVM’s comments submitted to the U.S. Preventive Services Task Force on the draft recommendations for coverage of routine HIV screening services.

AAHIVM & Testing Reimbursement Workgroup Comments to USPSTF on Coverage of HIV Testing
A Letter from AAHIVM, and the Federal AIDS Policy Partnership, Health Care Access Working Group, Testing Reimbursement Workgroup on the U.S. Preventive Services Task Force draft recommendations for coverage of routine HIV screening services.

Letter to Centers for Disease Control and Prevention (CDC) on the Revised Recommendations for HIV Testing 03.27.2006
A Letter from AAHIVM to the CDC on the Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health Care Settings.

AAHIVM Position Paper: HIV Prevention and Progress 2003
A position paper by AAHIVM on HIV Prevention and Progress advising Congress to recognize successes and reevaluate the limited strategies of HIV prevention.

LEARN MORE

Below are some additional resources on the issue of HIV Testing Policy and HIV Testing Reimbursement.

The U.S. Preventative Services Task Force Final Recommendations on Coverage of Routine HIV Testing 2013

The Centers for Disease Control and Prevention (CDC) 2006 Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings

Clinical Resources:

Visit AAHIVM’s Routine HIV Testing page under the provider resources section, to learn more about the clinical aspects of Routine HIV Testing and to access the Routine HIV Testing Toolkit and the Reimbursement Coding Guide for Routine Testing

Testing Laws:

The National Clinicians Consulatation Center publishes a Compendium on State HIV Testing Laws that details HIV testing laws in each state.

Testing and Health Reform:

The Healthcare Access Working Group and HIVHealthReform.org presented a webinar August 23, 2012, on how the Affordable Care Act will expand access to HIV prevention and testing services, including what preventive services will be covered by Medicaid, Medicare or private insurance plans, the women’s preventive services package, and the important role the U.S. Preventive Services Task Force plays in coverage determinations. CDC staff members participated.
Video: How will the Affordable Care Act expand access to HIV prevention and testing services?
Slides: How will the Affordable Care Act expand access to HIV prevention and testing services?

Testing and Medicaid:

Podcasts:

CDC Podcast on National HIV Testing Day National HIV Testing Day is June 27th each year. Listen to this podcast from the Centers for Disease Control and Prevention (CDC) on the importance of HIV testing, on National HIV Testing Day.